ZONING PERMIT APPLICATION TOWN OF MIDDLEBURY
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PROPERTY OWNER(S)__________________________________________________

ADDRESS : _____________________________________________________________

PHONE NO: Home______________________          Work ________________________

DATE OF APPLICATION: ___________________________________________

OWNER’S AGENT IF ANY: ________________________________________________

(NOTE: If an owner’s agent signs the application, the application must be accompanied by a letter of agency in favor of the agent with owner’s signature and 2 witnesses.)

PHONE NO . Home______________________          Work ________________________

CATEGORY OF APPLICATION
I.CHANGE OF USE OF EXISTING BUILDING OR STRUCTURE __________________

2.PROPOSED BUILDING OR STRUCTURE AND USE THEREOF ________________

3.CERTIFICATE FOR A LAWFUL NON-CONFORMITY __________________________

4.USE OF LAND __________________________________________________________

5.SPECIAL EXCEPTION____________________________________________________

PROPERTY DATA

ZONING DISTRICT _________       AREA OF LOT(SQUARE FEET/ACRES)_____

LOCATION OF LOT (STREET ADDRESS)________________________________

SUBDIVISION NAME( if applicable) ______________________________________

ASSESSOR’S MAP NO. _________      LOT NO._________

THERE ARE ______(#) EXISTING BUILDINGS AND STRUCTURES ON THE LOT AS INDICATED BELOW:

TYPE/USE	GROUND/COVERAGE (sq. feet)	TOTAL LIVING FLOOR AREA (sq feet)
1.
2.
3.
4.